Health Equity Planner to Implement and Spread Child Safety Strategies in Communities
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Health Equity Planner to Implement
and Spread Child Safety Strategies
in Communities
A TOOL FOR PUBLIC HEALTH AND TITLE V AGENCIES
This project is supported by the Health Resources and
Services Administration (HRSA) of the U.S. Department of
Health and Human Services (HHS) under the Child and
Adolescent Injury and Violence Prevention Resource Centers
Cooperative Agreement (U49MC28422) for $5,000,000
with 0 percent financed with non-governmental sources. This
information or content and conclusions are those of the
SEPTEMBER 2021
author and should not be construed as the official position
or policy of, nor should any endorsements be inferred by
HRSA, HHS or the U.S. Government.Health equity is the attainment of the highest level of health for everyone and no one is
disadvantaged from achieving this potential because of any socially defined circumstances (Whitehead
& Dahlgren, 2007). Acknowledging the role of social determinants of health (i.e., economic and social
conditions in the places where people live, learn, work, and play) can help advance health equity
in child safety work. The Health Equity Planner to Implement and Spread Child Safety Strategies in
Communities (Health Equity Planner) is a tool for state and jurisdiction health departments and other
Title V agencies to provide guidance for the promotion of health equity in child safety.
The Health Equity Planner is for use at the departmental and/or programmatic/work unit level to
assess integration of health equity approaches in child safety initiatives. The Health Equity Planner
may be used as a stand-alone tool or with the CSN Framework for Quality Improvement and Innovation
in Child Safety: A Guide to Implementing Injury and Violence Prevention Strategies and Programs. The
CSN Framework puts forth the theory that application of Leadership and Management, Child Safety
Expertise, and Systems Improvement will contribute to advances in injury and violence prevention
systems and workforce development, which will contribute to positive health impact for children.
The Health Equity Planner is divided into five sections, with the latter three aligning with the CSN
Framework: Social Determinants of Health, Scope of Work, Leadership and Management, Child Safety
Expertise, and Systems Improvement.
For Title V agencies that would like technical assistance in using the Health Equity Planner,
please submit a TA request to CSN.
Upon completion of the Health Equity Planner, by section or in entirety, departments or programs/
work units are expected to integrate health equity into the implementation and spread of their
evidence-based and evidence-informed strategies. This tool can be used to facilitate planning with
key stakeholders on how health equity can be addressed at all levels of the social-ecological model.
The Planner can help bring to light additional areas of improvement necessary for success, such as
staff training and education, partnership development, community engagement, and recruitment.
Programmatic planning should include the implementation and spread of evidence-based and
evidence-informed strategies and a health equity approach, which may require adaptations and further
testing in diverse populations and settings.
2OVERALL INSTRUCTIONS
This tool can be completed by one person or a team; at the department/agency or program/work unit
level.
Each section of the Health Equity Planner is divided into three phases, that follow a quality
improvement approach:
1. Assess
2. Plan and Test
3. Monitor, Revise and Adapt
There are two columns in each phase: Department/Agency and Program/Work Unit. The team or
individual completing the tool may find it useful to complete both columns to see alignment and
relationships between the agency/department and program/work unit.
The team or individual completing the tool can answer questions in each phase based on where
they are in their planning for health equity. Responses will be as macro or micro level as necessary,
depending on who is completing the planner and the work undertaken.
Go to Planner Navigation on the next page to begin integrating a health equity approach to your child
and adolescent safety work
3Planner Navigation
While the planner is designed as a comprehensive tool we want you to focus on where your work
is now, To get started, click the section(s) that best fits your child and adolescent safety work.
Overall Instructions......................................................................................... 3
Section I: Social Determinants of Health........................................................... 5
Section II: Scope of Work................................................................................. 7
Section III: Leadership and Management.......................................................... 9
Section IV: Child Safety Expertise................................................................... 12
Section V: Systems Improvement................................................................... 17
State Examples............................................................................................. 20
Glossary....................................................................................................... 21
References................................................................................................... 23
4SECTION I: SOCIAL DETERMINANTS OF HEALTH
Social determinants of health are “the conditions in the environments where people are born, live,
learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life
outcomes and risks” (Healthy People 2030). Social determinants of health (Centers for Disease
Control and Prevention [CDC], 2020a) affect a wide range of risks and health outcomes.
INSTRUCTIONS
To begin your work towards health equity, consider the social determinants of health affecting the
communities/populations you are serving (e.g., housing, quality and access to social services,
education and healthcare, geographic location, economics, discrimination, etc.). Work with your
epidemiologist or data managers to obtain health disparities data for the population(s) you are
addressing. At each phase, identify any next steps you need to take. To return to the planner
navigation, click here.
1. Assess Department/Agency Program/Work Unit
Broadly identify the social determinants of
health for your population(s) of interest
Identify health disparities data for your
population(s) of interest
What are your next steps (e.g., who will you
share and discuss these determinants and
data with)?
2. Plan and Test Department/Agency Program/Work Unit
Which of the social determinants of health will
you prioritize addressing for your population(s)
of interest?
Which health disparities data will you monitor?
52. Plan and Test Department/Agency Program/Work Unit
What are your next steps (e.g., do you have
an epidemiologist or data manager on your
team)?
3. Monitor, Revise, and Adapt Department/Agency Program/Work Unit
What does your data trend tell you about the
work you are undertaking?
How can you use your data over time to drive
decision making?
Are there other data representing social
determinants for your population that would
be helpful to monitor?
What are your next steps?
6SECTION II: SCOPE OF WORK
Consider your aim for promoting health equity in the population(s) you serve. What is your
department/agency and/or program/work unit’s aim statement for promoting health equity? Does
your department/agency and/or program/work unit have specific goals identified?
INSTRUCTIONS
In this section, begin by considering the aim (i.e. objective) you would like to achieve. Is your aim
written as a SMART aim statement: specific, measurable, attainable, realistic, and time bound? Do
you have goals that will help you achieve your aim statement? As you progress through your work,
revisit your SMART aim and goals and consider if you need to adjust them based on new information
or community feedback. This should be an iterative process. To return to the planner navigation,
click here.
1. Assess Department/Agency Program/Work Unit
What aim will promote health equity in your
population(s) of interest?
Is your aim SMART?1
Write a SMART aim statement (specific,
measurable, attainable, realistic, time-bound)
that identifies the population you will work
with, the social determinants you will address,
the strategies you will implement, and the
improvement you aim to make over a specific
time frame.
What are your next steps (e.g., Do you need
more data to write your aim statement? Who
needs to be involved in writing and building
consensus for the aim statement)?
1 Example of a SMART aim statement: By April 2025, there will be a 50% increase over the state baseline in the number of Black and
Hispanic students screened for suicide risk in school
72. Plan and Test Department/Agency Program/Work Unit
How are you integrating community feedback
in your SMART aim?
What goals will move you toward achieving
your aim statement (e.g., How can you break
up your work into distinct goals you can
prioritize over time? How will you reach your
population(s) of interest)?
What are your next steps?
3. Monitor, Revise, and Adapt Department/Agency Program/Work Unit
Are you making progress toward your aim (e.g.
Are you seeing the change(s) you expected?
Are you seeing any unexpected or unintended
results)?
Do you need to adjust your aim based on new
information you have learned (e.g., ongoing
evaluation, community feedback)?
What are your next steps?
8SECTION III: LEADERSHIP AND MANAGEMENT
Leadership and management are critical to achieving health equity in child safety. Leadership enables
people to address challenges in complex systems and management organizes systems, resources
and tasks in reliable ways. Strong leadership and management build and strengthen partnerships,
inspire teams, ensure data is used to inform decision making, improve operations, and lead to
results.
INSTRUCTIONS
In this section, consider who will champion health equity in your department/agency or program/work
unit. Consider how health equity is prioritized and institutionalized in your child safety work. To return
to the planner navigation, click here.
1. Assess Department/Agency Program/Work Unit
Is there a designated person with authority Yes Yes
and influence in your department/agency
No No
or program/work unit who is responsible for
integrating health equity in your child safety Unsure Unsure
work (e.g., colleague in an office or division of
health equity, senior leadership, etc.)?
If yes, who is this person/team?
If yes, is health equity widely prioritized across
your department/agency or program/work
unit’s child safety strategic aim/goals?
If no, who is the best candidate to promote
health equity in your child safety work?
If unsure, who could you contact to find out?
Does your department/agency or program/ Yes Yes
work unit have a vision, strategic plan, and/or
No No
operational plans for how to advance health
equity? Unsure Unsure
91. Assess Department/Agency Program/Work Unit
If yes, what is your department/agency’s or
program/work unit’s vision, strategic plan,
and/or operational plans? What policies
or documents exist and how can they be
accessed?
If no, what steps can you take to develop a
vision statement?
If you are unsure, who could you contact to
find out?
What are your next steps?
2. Plan and Test Department/Agency Program/Work Unit
How does your SMART aim statement
to promote health equity relate to your
department/agency’s or program/work unit’s
vision and/or strategic and operational plans?
Who in your department/agency and/or
program/work unit should you communicate
your SMART aim statement with?
How will you work with others in your
department/agency and/or program/work unit
to ensure your SMART aim statement remains
a priority (e.g. Does it become part of the
strategic plan or operational plans)?
What are your next steps?
103. Monitor, Revise, and Adapt Department/Agency Program/Work Unit
Is your team inspired to work toward your aim
statement?
If yes, how can you continue to inspire and
encourage your team?
If no, how can you enable your team to face
challenges and be encouraged in their work?
What changes will you make?
If unsure, how can you find out? Who will you
ask?
Is your aim statement supported by sufficient
resources (e.g., funding, staff operating rules,
systems, materials, etc.)?
If yes, how do you ensure sustainability of
resources?
If no, what is lacking and how will you work to
resource the work?
If unsure, how will you find out?
What are your next steps?
11SECTION IV: CHILD SAFETY EXPERTISE
Child safety expertise is a necessary component in building health equity in child safety programs.
Child safety expertise is full technical knowledge and experience in injury and violence prevention
among 0 to 19 year olds. It includes knowledge of evidence-based and evidence-informed strategies
and programs across various demographics and settings.
INSTRUCTIONS
In this section, consider the ways you engage a diverse community of stakeholders who are
knowledgeable and understanding of your population(s) of interest’s needs. Consider how you engage
with community leaders to guide your programming from planning to evaluation. To return to the
planner navigation, click here.
1. Assess Department/Agency Program/Work Unit
Are you engaging a diverse community of Yes Yes
stakeholders who are representative of your
No No
population(s) of interest and understanding
of their needs (e.g., community leaders, Unsure Unsure
teachers, counselors, nurses, pediatricians,
parents, youth)?
If yes, who are the community stakeholders
and do you have a plan for engaging them
throughout the implementation and spread
process (e.g., stakeholder analysis with clear
roles and time frame)?
If yes, how are you engaging them? How are
you incorporating their feedback?
If no, what actions can you take to increase
representation?
If no, what actions can you take to develop
a plan to engage individuals representing
the population(s) of interest (e.g., form
workgroups, hold stakeholder meetings, etc.)?
If you are unsure, how can this be clarified?
121. Assess Department/Agency Program/Work Unit
What are your next steps?
Are you using a multi-level approach, such as Yes Yes
the social-ecological model, to promote health
No No
equity in your work (e.g., societal, community,
relationship, and individual level strategies, Unsure Unsure
practices, policies, or programs that may be
focused on healthcare, poverty, food, crime,
discrimination, education, social supports,
etc.)?
If yes, what strategies, practices, policies Societal Societal
or programs are you implementing at the
different levels of the social-ecological model?
Community Community
Relationship Relationship
Individual Individual
If no, what levels could you work across?
If you are unsure, how can this be clarified/
who can you work with to understand this
better?
131. Assess Department/Agency Program/Work Unit
What are your next steps (e.g., do you need
more information on child safety strategies
and programs across the social-ecological
model)?
Are you implementing evidence-based or Yes Yes
evidence-informed child safety strategies that
No No
integrate culturally-tailored approaches (i.e.,
taking into account the population’s unique Unsure Unsure
experiences, values, beliefs and behaviors
that impact health)?
If yes, which strategies are you implementing?
If you have tailored the strategies, please
provide a description of the adaptations for
your population.
If no, why not and how can you integrate
culturally-tailored approaches moving
forward?
If unsure, how can you explore and clarify
this?
What are your next steps?
142. Plan and Test Department/Agency Program/Work Unit
For each level of the social-ecological model,
what strategies and programs are not working
as expected and what can you test to make
improvements (e.g., are they culturally-
tailored, when is the program offered, who is it
offered to, how)?
Are there additional strategies and/or
programs you want to test?
What is your plan to test changes to existing
strategies and/or programs (e.g., who, what,
when, where, how)?
What is your plan to test additional strategies
and/or programs (e.g., who, what, when,
where, how)?
What are your next steps?
3. Monitor, Revise, and Adapt Department/Agency Program/Work Unit
How often are you monitoring the impact of
your child safety strategies and programs?
How are you monitoring each child safety
strategy or program?
Are the strategies and programs effective? If
not, what can you revise or adapt?
153. Monitor, Revise, and Adapt Department/Agency Program/Work Unit
Are the strategies and programs sustainable?
If not, what can you revise or adapt?
What are your next steps?
16SECTION V: SYSTEMS IMPROVEMENT
Engaging in ongoing systems improvement helps states and jurisdictions develop a comprehensive
understanding of their child safety system, identify gaps in their system, and plan and manage quality
improvement initiatives that will improve their systems and ultimately contribute to the well-being of
the population(s) they serve.
INSTRUCTIONS
In this section, consider your department/agency or program/work unit’s use of health disparities
data to inform selection, testing, implementing, and spreading child safety strategies and programs.
Consider how you address access to various components of your child safety system. To return to the
planner navigation, click here.
1. Assess Department/Agency Program/Work Unit
Do you regularly analyze and use available Yes Yes
health disparities data to inform your child
No No
safety strategies and/or programs (i.e., data
that shows differences in outcomes between Unsure Unsure
groups based on their social and economic
conditions, such as race/ethnicity, disability,
income, educational attainment; other social
determinant of health measures)?
If yes, how do you use this information (e.g.,
selection of strategies/programs, where
strategies/programs are implemented, etc.)?
If no, what do you need to begin integrating
data into your work?
If you are unsure, who can you work with
and what can you do to start using data to
make programmatic decisions (e.g., state
epidemiologists or data managers)?
If no, what actions can you take to develop
a plan to engage individuals representing
the population(s) of interest (e.g., form
workgroups, hold stakeholder meetings, etc.)?
What are your next steps?
172. Plan and Test Department/Agency Program/Work Unit
For each of the child safety strategies and/
or programs you identified, have you planned
for access with respect to advancing health
equity for your population(s) of interest in
your aim statement (e.g., access to services,
access to resources, provision of education,
research, developing departmental/agency
and/or program/work unit policy)? Ask your
team the below questions for each child safety
strategy.
If yes, how have you planned for this and what
have you learned?
Have you addressed physical access? Yes Yes
No No
Unsure Unsure
Have you addressed virtual access? Yes Yes
No No
Unsure Unsure
Have you addressed health literacy? Yes Yes
No No
Unsure Unsure
Have you addressed disabilities (e.g., ASL Yes Yes
services, ADA inclusion, etc.)?
No No
Unsure Unsure
Have you addressed stigma (e.g., race/
ethnicity, religious status, socioeconomic
status, sexual orientation, disability,
homelessness, mental health, etc.)?
Have you addressed economic barriers (e.g.,
housing, transportation, childcare, etc.)?
Have you addressed other equity
considerations? (list/describe):
182. Plan and Test Department/Agency Program/Work Unit
If no, who can you work with to plan for
equitable access (e.g., health department
leaders, partners, workgroups, community,
etc.)?
If you are unsure, how can this be clarified?
What are your next steps?
3. Monitor, Revise, and Adapt Department/Agency Program/Work Unit
What is your data collection and monitoring
plan to track improvement in health equity?
How will progress on health equity be
measured (e.g., measuring reductions in risk
factors, injury disparities, or socioeconomic
inequalities across racial/ethnic groups)?
What key performance indicators will you
track, what data sources will you use, and how
often will you collect and monitor data?
Who will be responsible for (a) collecting, (b)
analyzing and (c) sharing the data?
What are your next steps?
193. Monitor, Revise, and Adapt Department/Agency Program/Work Unit
What is the system for sharing findings on
progress towards health equity (e.g., identified
barriers/challenges, lessons learned, success
stories or data on reductions in health
disparities)?
How will the findings on health equity be
communicated in your department/agency
and/or program/work unit?
How will the findings on health equity be
communicated with stakeholder organizations
(e.g., schools, health clinics, hospitals, after
school programs, etc.) and populations (e.g.,
youth, parents, caregivers, etc.) you are
working with that are directly impacted?
How will the findings and lessons learned
be communicated to any local, state, and
national stakeholders (e.g., local communities
you are working with, local organizations, state
departments, state task forces, cross state
coalitions, etc.)?
What are your next steps?
STATE EXAMPLES
Colorado Department of Public Health and Environment, Office of Health Equity
https://cdphe.colorado.gov/ohe
Florida Department of Health, Bureau of Community Health Assessment, Division of Public Health
Statistics and Performance Management, 2019. Health Equity Profile 2019
http://www.flhealthcharts.com/ChartsReports/rdPage.aspx?rdReport=ChartsProfiles.
HealthEquityMergeMHProfile
Rhode Island Department of Health, Health Equity Zones Initiative
https://health.ri.gov/programs/detail.php?pgm_id=1108
To return to the planner navigation, click here.
20GLOSSARY
Child Safety Expertise is full technical knowledge and experience in injury and violence prevention
among 0 to 19 year olds. It includes knowledge of evidence-based and evidence-informed strategies
and programs across various demographics and settings.
CSN Framework for Quality Improvement and Innovation in Child Safety puts forth the theory that
application of Leadership and Management, Child Safety Expertise, and Systems Improvement will
contribute to advances in injury and violence prevention systems and workforce development, which
will contribute to positive health impact for children.
Health Disparity is a metric used to measure progress toward achieving health equity.
Health Equity is the attainment of the highest level of health for everyone and no one is
disadvantaged from achieving this potential because of any socially defined circumstances (Whitehead
& Dahlgren, 2007).
Leading means enabling others to face challenges and achieve results under complex conditions
(Management Sciences for Health, 2005).
Managing means organizing the internal parts of the organization to implement systems and
coordinate resources to produce reliable performance (Management Sciences for Health, 2005).
Phases of Planning for Health Equity
1. Assess is the first phase, where departments/agencies or program/work units conduct
scans of their current efforts towards advancing health equity.
2. Plan and Test is the second phase, where departments or program/work units start
addressing health equity using specific strategies.
3. Monitor, Revise, and Adapt is the third phase, where departments or program/work units
monitor their progress, revise their initial understanding, and adapt their strategies based
on additional information they learned while actively addressing health equity in their
contexts.
SMART Aim Statement (Objective) is a way to move ideas to action by being specific, measurable,
attainable, realistic, and time-bound. A SMART aim statement (objective) for health equity identifies
the population you will work with, the conditions you will address, and the strategies you will
implement and spread.
Social Determinants of Health are “the conditions in the environments where people are born, live,
learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life
outcomes and risks” (Healthy People 2030, 2020). Healthy People 2030 identifies five major domains
of social determinants of health: Education Access and Quality, Health Care Access and Quality,
Neighborhood and Built Environment, Social and Community Context, and Economic Stability.
21Social-Ecological Model helps us consider the complex “interplay between individual, relationship,
community, and societal factors” (Bronfenbrenner, 1977). In planning for implementing and spreading
child safety strategies, we can use the model to identify and address various factors that may affect
the health outcomes of children and adolescents.
Systems Improvement encompasses developing a comprehensive understanding of your child safety
system; the aim, inputs, processes and outputs of your system; an assessment and identification
of gaps or bottlenecks in the system; and planning and managing quality improvement initiatives to
improve your system and ultimately contribute to the well-being of the population(s) you serve.
To return to the planner navigation, click here.
22REFERENCES
Braveman, P., Arkin, E., Orleans, T., Proctor, D., & Plough, A. (2017). What is health equity? And what
difference does a definition make? Princeton, NJ: Robert Wood Johnson Foundation.
Centers for Disease Control and Prevention. (2020a). Social determinants of health: Know what
affects health. Retrieved September 28, 2020 from https://www.cdc.gov/socialdeterminants/
index.htm
Centers for Disease Control and Prevention. (2020b). The social-ecological model: A framework for
prevention. Retrieved September 28, 2020 from https://www.cdc.gov/violenceprevention/
publichealthissue/social-ecologicalmodel.html
Children’s Safety Network. (2019). Framework for quality improvement and innovation in child safety:
A guide to implementing injury and violence prevention strategies and programs. https://www.
childrenssafetynetwork.org/resources/framework-quality-improvement-innovation-child-safety-
guide-implementing-injury-violence
Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention
and Health Promotion. Retrieved May 7, 2021 from https://health.gov/healthypeople/objectives-
and-data/social-determinants-health
Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based
practice: A conceptual framework. Quality in Health Care, 7, 149-158.
Management Sciences for Health (2005). Managers who lead: A handbook for improving health
services. Cambridge: Massachusetts.
Whitehead M, Dahlgren G. (2007). Levelling up (Part 1): Concepts and principles for tackling social
inequities in health. World Health Organization. Retrieved September 28, 2020 from http://www.
euro.who.int/document/e89383.pdf
Wyatt, R., Laderman, M., Botwinick, L., Mate, K., & Whittington, J. (2016). Achieving health equity:
A guide for health care organizations. Cambridge, MS: Institute for Healthcare Improvement.
http://www.ihi.org/resources/Pages/IHIWhitePapers/Achieving-Health-Equity.aspx
Facebook: facebook.com/childrenssafetynetwork
Children’s Safety Network
Twitter: twitter.com/ChildrensSafety
43 Foundry Avenue
Pinterest: pinterest.com/childrenssafety
Waltham, MA 02453
Newsletter: go.edc.org/csn-newsletter
23You can also read
